tkworld Chapter 1400: Professor Yang's students are truly exceptional.
Chapter 1400: Professor Yang's students are truly exceptional.
Chapter 1400: Professor Yang's students are truly exceptional.
The next morning at seven o'clock, Zhang Lin was already standing in front of the nurses' station on the seventh floor, reviewing the night shift handover records. Head Nurse Liu Min, who had just changed her clothes, was surprised to see him: "Director Zhang, you're here so early?"
“I’m used to it,” Zhang Lin said without looking up.
He barely slept last night. The unfamiliar environment, the unfamiliar bed, and the swirling questions in his mind: Could he manage to keep this up?
At 8:00 AM sharp, Dean Chen, accompanied by the head of the medical affairs department and the director of the nursing department, arrived at the orthopedic center again and publicly read out the official appointment document at the department's morning meeting.
All medical staff in the spinal surgery department assembled, with Dean Chen standing at the front, holding two documents stamped with the official seal:
"Comrades, I now announce the decision of the hospital's Party Committee: Comrade Zhang Lin will serve as the Director of the Spinal Surgery Department of the Orthopedic Center, fully responsible for the department's medical, teaching, and research work. I hope all colleagues in the department will support Director Zhang's work and work together to elevate the level of spinal surgery in our hospital to a new level."
Zhang Lin took the document and showed it to everyone. The red official seal, the black lead type, and the heavy paper represented the hospital's trust and also its heavy responsibility.
"I'd like to say a few words," Dean Chen said, surveying the room. "Director Zhang is an academic leader brought in from Sanbo Hospital, and he has profound expertise in the field of spinal surgery. I know some of our colleagues are more senior than Director Zhang and may have their own reservations. But I'm making this clear today: seniority is seniority, and ability is ability. The hospital needs fresh blood, new technologies, and new ideas for its development. Anyone with opinions can come and talk to me, but cooperation is essential; this is an organizational principle."
These words carried weight, and the audience fell silent. Zhang Lin noticed that Wang Shunye and several other senior figures had their heads bowed, their expressions unreadable.
"Director Zhang," Dean Chen turned to him, "you'd like to say a few words."
Zhang Lin stepped forward, his voice low but clear: "I've kept Dean Chen's words in mind. I know I'm young and inexperienced, and many of the teachers here are older and more experienced than me. I wouldn't dare say I'm better than everyone, only that I'm luckier—lucky to have worked with Professor Yang at Sanbo for several years and seen more cases. In my future work, I will share everything I learned at Sanbo with everyone without reservation. Let's progress together and make the department better."
Immediately afterwards, on the eighth floor, the same process took place. In the doctors' offices, doctors and nurses stood in a line. Dean Chen announced the appointments, and Xiao Wu stepped forward to express his gratitude.
"Hello everyone, I'm Lu Xiaowu, you can just call me Xiaowu. That's what my colleagues called me when I was at Sanbo, it's a familiar and friendly way to address people," he said with a smile, his gaze sweeping across the room. "To be honest, standing here today, I'm a little nervous. It's not because I'm afraid of taking responsibility, but because seeing so many senior teachers makes me feel inexperienced and lacking in seniority. I'm afraid of letting down the trust of the college leaders and of not being able to lead this team well."
He paused, then said sincerely, "But then I thought, what kind of place is our eighth floor? It's the city hospital's flagship department, a place that Director Zhao and everyone worked their way up from the ground up. What merit do I, Lu Xiaowu, have to take over this position? It's not because I'm better than others, but because I'm lucky—lucky to have had good teachers at Sanbo, lucky to have seen some cases, and lucky to have learned a few tricks."
Zhao Quan stood in the front row, his smile becoming more natural.
"So I've been thinking, how should I be the director?" Xiao Wu continued, "It can't be me managing you all; we have to work together. I'll share everything I learned at Sanbo Hospital without reservation. I'll also humbly learn from the experience accumulated by all the teachers. Let's learn from each other, complement each other's strengths and weaknesses, and make the eighth floor's reputation shine even brighter, so that when people outside mention the Orthopedics Department of the Municipal Hospital, they'll give it a thumbs up!"
Some people in the audience nodded slightly, and the atmosphere was noticeably more relaxed than on the seventh floor.
“Of course,” Xiao Wu changed the subject, but her tone remained gentle, “Sanbo has some good rules, and I think they’re good. I’d like to gradually introduce them into our department. For example, a more thorough preoperative assessment means greater patient safety; more standardized surgical procedures lead to better long-term outcomes; and more effective postoperative management reduces complications. These things build a good reputation for our department and benefit patients. What do you all think?”
He looked at Zhao Quan with a questioning look in his eyes, not a command.
Zhao Quan paused for a moment, then nodded: "Director Lu is right, this is what we should do."
“With Director Zhao’s support, I feel confident,” Xiao Wu said with a smile. “How to implement it specifically still depends on Director Zhao and all the teachers discussing it together. I’m young and may not have considered everything thoroughly, so please offer your suggestions, and let’s pool our wisdom and efforts. In short, we have the same goal: to do what’s best for the patients and the department. Let’s work together to make the eighth floor a thriving success! Then we can all present our work at academic conferences and gain recognition in the industry.”
Applause erupted from the audience, much more enthusiastic than on the seventh floor. Xiao Wu bowed in thanks, his gesture perfectly measured, both humble and courteous.
Dean Chen watched from the side, nodding slightly. This Lu Xiaowu is eloquent and knows how to get along with people; he's more tactful than Zhang Lin and can unite people.
The morning meeting had just ended, and Zhang Lin was about to go make his rounds when his phone suddenly rang. It was the head of the medical affairs department, his voice urgent: "Director Zhang, come to the emergency room quickly! There's a seriously injured patient. Dean Chen wants you and Director Lu to go together!"
Zhang Lin and Xiao Wu rushed to the emergency department.
The emergency room was in complete chaos. A man in his thirties lay on a stretcher, covered in blood, his head pinned to the ground by a neck brace, his pelvis hastily bandaged with a sheet, the blood soaking through the thick fabric. The monitor emitted a piercing alarm; his blood pressure was 80/50, and his heart rate was 130.
"What's going on?" Zhang Lin asked while putting on his mask.
The head of the emergency department quickly reported: "Car accident injury, rear-end collision on the highway, steering wheel crushed chest and abdomen, also with whiplash injuries. The local hospital provided basic treatment before transferring here. Preliminary assessment: cervical spine injury, likely atlantoaxial fracture; pelvic fracture, hemorrhagic shock; multiple rib fractures, hemopneumothorax."
Zhang Lin gasped. The upper cervical spine was injured, the most dangerous area in spinal surgery. The medulla oblongata and vertebral artery are located around the atlantoaxial joint; even a slight mishandling could result in immediate death or high-level paraplegia. It was incredibly fortunate this patient had survived to reach the hospital; the vast majority of such patients die at the scene. A pelvic fracture combined with shock was also extremely dangerous. With both areas severely injured simultaneously, the surgical difficulty increased exponentially.
"Where's the footage?"
"The CT scan is in progress, you'll be out soon."
Dean Chen arrived, his face grave. He looked at the patient, then at Zhang Lin and Xiao Wu: "Can our hospital handle this patient?"
Zhang Lin did not answer immediately. He walked to the bedside and quickly examined the patient: the patient was confused, and the muscle strength in all four limbs was significantly reduced, especially in both upper limbs, which was only grade two. This was a typical manifestation of upper cervical spine injury, with spinal cord compression, and the patient could become completely paralyzed at any time.
“The upper cervical spine requires surgical decompression and fixation, and the pelvis requires external or internal fixation,” Zhang Lin said. “Both surgeries are very complex, especially the upper cervical spine surgery, which carries extremely high risks.”
"Transferring to another hospital?" Dean Chen asked. "To Sanbo Hospital?"
“It’s too late,” Xiao Wu pointed to the monitor. “His blood pressure is still dropping, the pelvic fracture is causing massive bleeding, and he could die at any moment on the way to the next hospital. Furthermore, his upper cervical spine is unstable; even a slight bump during transport could completely damage his spinal cord, rendering him useless.”
"That?"
Zhang Lin and Xiao Wu exchanged a glance, and both saw the same decision in each other's eyes.
“We’ll do it,” Zhang Lin said. “I’ll be the lead surgeon for the cervical spine, and Chief Physician Lu will be the lead surgeon for the pelvic spine. We’ll perform both surgeries simultaneously to save time.”
Dean Chen was stunned. He knew these two men were from Sanbo Hospital, but he hadn't expected them to dare take on such a difficult surgery. Cervical spine surgery was something the city hospital dared not and could not perform. Pelvic fracture surgery was common, but combined with such severe shock, the risks were extremely high.
"Are you confident?" Dean Chen asked.
“There’s no absolute certainty,” Zhang Lin said honestly, “but if we don’t do it, the patient will be 100% dead or paralyzed. If we do it, there’s a slim chance. If we send this kind of patient out now, they’ll likely die on the way.” Xiao Wu said, “A pelvic fracture combined with shock—the sooner the fixation and hemostasis are achieved, the greater the chance of survival. Another half hour of delay, and even a miracle won’t save them.”
Dean Chen was silent for a few seconds, then nodded emphatically: "Good! Just say what you need, and we'll allocate all the resources in the hospital to you!"
The CT scan results came back, and they were even worse than expected.
The patient suffered a burst fracture of the atlas, a fracture and dislocation of the odontoid process of the axis, and spinal cord compression. The pelvis was a Tile C fracture, the most unstable type, with fractures of the superior and inferior pubic rami bilaterally, separation of the sacroiliac joints, complete rupture of the posterior ring, and massive hematoma in the pelvic cavity.
"Save lives first, then treat injuries," Zhang Lin quickly devised a plan. "Xiao Wu, you go first, set up the external fixator for the pelvis, quickly stop the bleeding, and stabilize hemodynamics. I'll prepare for cervical spine surgery at the same time. Once you're stable, I'll go on."
Xiao Wu shook his head. "External pelvic fixation is simple; I'll have Zhao Quan do it. I'll accompany you for the upper cervical spine surgery. That other surgery is too risky; you need a trustworthy assistant."
Looking at Xiao Wu, Zhang Lin felt a surge of warmth in his heart. This was the tacit understanding they had developed at Sanbo; when faced with the most difficult surgeries, the two of them would go together, sharing life and death.
“Okay!” Zhang Lin said. “Then Director Zhao will do the external pelvic fixation, and the two of us will do the upper cervical spine.”
The surgery was arranged immediately, through the fast track.
Zhang Lin and Xiao Wu went to wash their hands, and the doctors and nurses they encountered along the way all looked at them with strange eyes. The news had already spread that the two new directors were going to take on a "death surgery," and some people admired them while others were waiting to see them make a fool of themselves.
"Are you nervous?" Xiao Wu asked.
"A little," Zhang Lin honestly admitted, "I've done quite a few upper cervical spine surgeries, but that was at Sanbo Hospital, they had all the equipment and the team was very experienced. Here..."
“This is our territory now,” Xiao Wu interrupted him. “From today onwards, this surgery will be a milestone for the spinal surgery department of the city hospital. If we succeed, we'll have a firm foothold; if we fail…”
"We have to make it happen, even if we can't," Zhang Lin said. "There's no turning back."
In the operating room, the head of the anesthesiology department personally took charge. For this type of patient, anesthesia is the first hurdle. The upper cervical spine is unstable, and even a slight movement of the neck after intubation could lead to complete spinal cord injury.
"Director Zhang, how do we insert it?" the head of the anesthesiology department asked.
“Awake intubation,” Zhang Lin said. “Local anesthesia first, fiberoptic bronchoscopy guidance, keep the cervical spine in a traction neutral position, absolutely no backward tilting or forward bending.”
This is standard procedure at Sanbo, but it's rarely performed in the city hospital's anesthesiology department. The head of anesthesiology, sweat beading on his forehead, nodded nonetheless: "Okay, I'll give it a try."
The intubation process was nerve-wracking. Zhang Lin stood at the head of the bed, and even though the patient was already in traction, he still firmly supported the patient's head with both hands, as if holding a fragile piece of porcelain. The head of the anesthesiology department carefully inserted the bronchoscope, each advancement accompanied by the alarm of the monitor.
"Your blood pressure dropped!"
"Administer dopamine to speed up the IV drip!"
"Blood oxygen is still dropping!"
Zhang Lin's hands were as steady as a rock, his eyes fixed on the monitor, and he gave instructions: "A little further in, yes, I can see the glottis, good, insert the catheter!"
The catheter was finally inserted and connected to the ventilator. Blood oxygen levels slowly rose, and everyone breathed a sigh of relief.
"Director Zhang, it's ready." The head of the anesthesiology department wiped his sweat.
Zhang Lin said, "For upper cervical spine surgery, the first step is intubation. If this step is wrong, everything afterward will be wrong. Let's continue. Turn over, into a prone position."
The upper cervical spine surgery has begun.
Zhang Lin opted for posterior atlantoaxial fusion and fixation. This approach is relatively safe, but it offers limited visibility and a small operating space, requiring extreme precision in every movement.
“Suction device,” Zhang Lin held out his hand. The scrub nurse was taken aback for a moment before realizing what he wanted. The instruments at the city hospital were different from those at Sanbo, their placement was different, and their coordination was not yet smooth.
Zhang Lin didn't complain. He reached for the suction device himself and began operating. He cut open the skin, peeled away the muscle, and exposed the spinous processes from the occipital bone to the third cervical vertebra. There was considerable bleeding, but it was all under control.
"Bone forceps," Zhang Lin said, "I need to open the spinal canal and relieve the pressure."
This is the most dangerous step. The medulla oblongata lies below the posterior arch of the atlas, and it is rich in epidural venous plexus. The slightest mistake could result in either spinal cord injury or massive hemorrhage.
Zhang Lin's hands moved very slowly. After each small piece of bone was removed, he would use a nerve dissector to probe and confirm the location of the dura mater. Under the microscope, his operation was precise to the millimeter level.
During their time at Sanbo, they knew they lacked talent, so they studied very diligently and performed surgeries slowly, prioritizing stability over speed.
Wang Shunye, the second assistant, was on tenterhooks.
“This kind of surgery can’t be rushed,” Zhang Lin explained to everyone without looking up. “Going fast means death, going slow means life. Look here, the vertebral artery is right next to us. If you rush it by even a millimeter, it will cause a burst of blood. This is the medulla oblongata; your life is in danger at any moment.”
Wang Shunye remained silent, watching Zhang Lin's operation. He had read about these techniques countless times in the literature but had never seen them in person. The meticulous operation under the microscope and the real-time feedback from the neurophysiological monitoring were all done steadily and without any room for luck.
With Xiao Wu assisting, the decompression was finally completed after two hours. Zhang Lin began to place the screws: lateral mass screws for the atlas and pedicle screws for the axis. The position of each screw was confirmed by fluoroscopy, and the angle, depth, and length were accurate to the millimeter.
Wang Shunye and the other doctors watched with admiration. They couldn't help but admire Professor Yang's students; even the menial workers were incredibly skilled, definitely top-tier in the country. The legendary two "King Kongs" must be even more formidable.